In order to reduce the extent of the wound after the excision of the fistula system in the pilonidal disease with subsequent open wound treatment, the so-called marsupialisation of the wound edges was introduced in the 1950s.
Marsupialization is a surgical technique that is normally used to treat cysts. The cyst is cut open lengthwise and its two incisal margins are sutured to the surrounding soft tissue. After cutting out the fistula system in the pilonidal disease, the edges of the skin are mobilized and sutured to cover the coccyx, which means that the wound in the fistula fold is usually no wider than 2 centimetres. As with excision, it must then heal on its own with open wound treatment. The procedure is performed under anaesthesia and requires a short stay in the hospital. As with excision with open wound treatment, wound care is performed by daily showering.
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The incidence of new tailbone fistulas following marsupialization in follow-up studies was 10 %, the average healing time was 3 to 4 weeks with an incapacity to work of 0.5 to 1.5 months.
Compared to excision with open wound treatment, marsupialisation reduces wound healing time and also the duration of incapacity to work at low recurrence rates. However, the wound care that is not very pleasant for the patient. The cosmetic result is also not necessarily appealing. Sewing the edges of the skin to cover the coccyx always leads to severe pain. In Germany, therefore, marsupialization plays no role in the treatment of the pilonidal sinus and is not recommended.
Literature sources:
Abramson DJ, Cox PA (1954) The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment. Ann Surg 139:341–349
Aydede H, Erhan Y et al (2001) Comparison of three methods in surgical treatment of pilonidal disease. ANZ J Surg 71:362–364
Ersoy OF, Karaca S et al (2007) Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J Med Sci 23:67–70
Solla JA, Rothenberger DA (1990) Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum 33:758–761
Meban S, Hunter E (1982) Outpatient treatment of pilonidal disease. Can Med Assoc J 126:941
Watters N, Macdonald IB (1958) Marsupialization of pilonidal sinus and abscess: a report of 50 cases. Can Med Assoc J 79:236–240
Füzün M, Bakir H et al (1994) Which technique for treatment of pilonidal sinus open or closed? Dis Colon Rectum 37:1148–1150
